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Revision total hip arthroplasty with correctional femoral osteotomy in Paget's disease
R S Namba1, G W Brick, W R Murray
1Department of Orthopaedic Surgery, University of California, San Francisco 94143-0728, USA.
Insights
Femoral component varus alignment in total hip arthroplasty for Paget's disease can lead to loosening. A diaphyseal femoral osteotomy successfully corrected deformities and allowed stable fixation with cementless implants.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Paget's disease of bone presents unique challenges in total hip arthroplasty (THA).
- Varus alignment of the femoral component is a known risk factor for aseptic loosening in THA.
- Revision THA in pagetic patients often involves complex bone irregularities and deformities.
Observation:
- Revision THA in three patients with Paget's disease revealed irregular, hemorrhagic bone and significant angular femoral deformity.
- Standard revision techniques were complicated by these intraoperative findings.
Findings:
- A diaphyseal femoral osteotomy was performed to facilitate cement removal and correct angular deformity.
- A step-cut configuration of the osteotomy provided rotational stability for a modular, long-stem cementless femoral implant.
- This approach resulted in excellent clinical and radiographic outcomes.
Implications:
- Diaphyseal femoral osteotomy is a viable technique for managing complex femoral deformities in revision THA for Paget's disease.
- Cementless modular implants can achieve stable fixation following corrective osteotomy.
- Surgeons should anticipate and plan for potential complications such as moderate blood loss and delayed osteotomy healing.
Abstract:
Varus alignment of the femoral component is associated with femoral component loosening in total hip arthroplasty performed for Paget's disease. Irregular and hemorrhagic bone, along with angular femoral deformity, was encountered during revision total hip arthroplasty in three pagetic patients. A diaphyseal femoral osteotomy facilitated cement removal and provided an opportunity for correction of the deformity. The step-cut configuration of the osteotomy provided intrinsic rotational stability of the femoral segments around a modular, long-stem cementless implant. Excellent clinical and radiographic results were achieved, but moderate blood loss and delayed healing of the osteotomy site were observed.